Perspectives on mental health
My take on mental health treatment in Singapore's context, examining broader contributing factors, treatment options, policy recommendations and personal advice
Mental health is a notoriously contentious topic around the globe, and Singapore is no exception. Most conversations around the topic happen under the veil of privacy, and so much more about it isn’t mentioned at all. Having personally struggled with depression and anxiety on two occasions, I thought it would be helpful to break down some of the perspectives and takeaways from my own experience, with the hope that it might provide some respite to anyone in need and help to start some serious conversations around the matter.
First, a disclaimer. All of these views are purely my own, and I am not a mental health professional by any means. I can only offer what I've gained from my own limited experience, and it’s fully possible that it may not be of any help to you. I understand that mental health is a deeply personal journey, and nobody can fully understand what you’re going through. But I hope you’ll believe me when I say that I'm writing this with only the best intentions. If even one thing here is of help to you, then this article would have served its purpose. Otherwise, feel free to point out any mistakes or oversights I've made in the comments or a personal email.
Perspectives
We can start off with the numbers. Our World in Data reports the global incidence of mental health conditions to be 10.7%, or about 1 in 10 (which they note as very likely to be an underestimation). Locally, the number is closer to 13.4% or about 1 in 7. Of all the age groups surveyed, young people aged 18-29 had the highest incidence of poor mental health. More recently, preliminary reports from the Singapore Youth Epidemiology and Resilience Study indicate that 1 in 3 youths aged 10 to 18 exhibit symptoms of mental health conditions.
Source: National Population Health Survey 2020
I have some doubts about the accuracy of these numbers. My hunch is that the true incidence rate is higher that what's been shown. Given the stigma associated with mental health conditions, I would bet that most of these values are under-reported. On top of this, the other argument I'm going to make (and something I'll revisit later on) is about generational differences in the way mental health is perceived. The vast majority of baby boomers and older generations hold a very reductive view of mental health in general, with the prevailing attitude that a formal diagnosis is basically the equivalent of a death sentence. I have no concrete data to back this up other than interactions I've had with my parents as well as personal accounts from friends. But if this is true, I would expect the incidence rate of mental health issues in older age groups to be higher as well. Regardless, the data clearly indicate that mental health is a compelling issue that urgently needs to be addressed.
Why is mental health becoming a problem for younger generations especially? There are plenty of comprehensive and rigorous accounts provided by journalists, writers and researchers with much more expertise than I have. There are the usual culprits: excessive technology use, information overload, climate change, increasing costs of living, work stress, debt, and the erosion of social communities. I agree that all of those factors certainly play a role, although some in very nuanced ways. However, I'd like to focus on some of the factors that have been more prominent for me personally, and ones that actually offer avenues for intervention:
Technology and social media in formative periods of life
The human brain - specifically, the prefrontal cortex - doesn't fully mature until the age of 25. Most of the time, the adolescent brain is trying to figure out the best patterns and behaviors for survival - which basically approximates to following what other adolescents are doing at the time. Social media basically hijacked this evolutionary adaptation and got a whole generation of teens struggling with excessive technology use, trying to keep relevant with the latest trends. It's certainly what I felt when I was younger (though I've thankfully grown out of it), and this desire to be socially accepted is much stronger for younger people. But with the incessant comparison that social media encourages, it's easy for youths to be overwhelmed or fed with unrealistic expectations about themselves - the whole argument that you're only seeing everyone else's highlight reels online.
The hope is that with time, we learn to be a bit more discerning and less prone to comparison whilst putting focus on the things that matter more - personal relationships, hobbies and work - but I think it's easier than ever to be tricked into living a purely performative life, spending energy on activities you don't enjoy to impress people you don't like. This slippery slope of striving towards external expectations rather than charting your own path is, in my opinion, a potent trigger for mental health issues in younger individuals.
The best way to avoid falling into this trap is to cultivate a strong sense of self - by pursuing hobbies and interests, and interacting richly with the world. Ask questions, try new things, and don't be afraid of looking like an idiot (my personal motto). The more you do this, the more you learn what brings you energy and joy, and the more comfortable you are in your own skin.
Lifestyle, diet, exercise and social activity
I believe that the well-being of mind and body are not separate - matters of mental health are bound up with physical health. While genetic factors play a role, the cocktail of hormones and neurotransmitters in our brains is heavily influenced by lifestyle factors like diet, sleep, exercise and social activity. Maintaining good habits and relationships which take care of all of these needs makes you that much more resilient against life stressors. Conversely, coming short in even one of these areas can be the trigger for a vicious cycle that erodes other protective factors and exacerbates existing problems. I intend to delve deeper into each of these topics in future articles, but for now I really want to highlight that maintaining healthy lifestyle habits and a support system of people you can trust is perhaps the best thing that you can do for yourself.
Here are some questions and prompts that might help for a simple lifestyle audit:
Diet - Start tracking your meals and mealtimes in any note-taking app, just to get an idea of what you eat on a weekly basis - is the bulk of your meals comprised of fresh and whole natural produce? Are there any substances (snacks, alcohol, caffeine, sugary drinks) that you might be consuming too much of? Are you staying properly hydrated throughout the day? Are you at risk of any micronutrient (vitamin, mineral, omega-3, etc.) deficiencies?
Sleep - What time do you go to bed, and when do you usually wake? How many hours of sleep do you get in a night? How would you rate the quality of your sleep? Is your bedroom environment (light, sound, temperature) conducive to sleep? Do you have a routine to wind down before bed?
Exercise - How often do you exercise in a week? Do you spend a lot of time in a sedentary state? Could you make some time during long periods of inactivity to do a a simple physical activity, like going for a walk?
Activity - Are there people you can trust and approach for help regarding personal struggles? Are there friends you haven't caught up in a long time, that you could reach out to reconnect with? Do you have social circles which you can share and develop your personal interests? Do the people around you inspire you and challenge you to grow?
Treatment, resources and help
If you are already in the midst of a mental health struggle, however, nothing I’ve suggested above might be appealing or within your capacity to implement. It may be feel like a monumental effort for you to simply get through one day -and if this is the case for you or someone you know, I do have some personal recommendations and resources to share, ordered by level of accessibility and financial cost:
Online videos, articles, and books - The internet has a wealth of resources for coping with mental health conditions and reframing some of the negative thought patterns that are common with disorders like anxiety and depression. I would personally recommend talks and books by individuals like Andrew Solomon, Robert M. Sapolsky, and Andrew Huberman for a more scientific and comprehensive view of mental health disorders. I also like videos by YouTubers like The School of Life, Campbell Walker, Sisyphus55 and Healthy Gamer. Online forums on Reddit can be a great starting resource as well.
Online support groups - Taking it a little step further, there are online support groups that you can access on platforms like Discord, Facebook or Meetup, which you can come across if you follow the rabbit hole of online forums long enough. You can interact with others who might be facing similar struggles or even arrange a physical meetup if those groups have a local slant. These groups are often very open and welcoming to newcomers, and benefit of online anonymity makes it a relatively safe and comfortable space.
Online therapy - There are an increasing number of online services tailored at providing therapy counselling services online. These services can vary in scale and offering, but are usually a bit more affordable and convenient. I haven't tried any of the offerings over a long-term period, but I think it's worth mentioning nonetheless. One thing to note about these services, however, is that there are real concerns with privacy and protection of user data. If you are considering this option, do take care to do some personal research of your own, and make sure you read the terms and conditions clearly.
Counseling and support groups - There are many avenues to find counseling services - whether through work, school, in a local community setting, or through specific volunteer organizations. These counselors will in turn be able to point you to more helpful resources - or even run peer support groups for people with similar conditions and struggles.
If you're not able to access any dedicated service, you can check out Blue Psychological Services - they offer pro bono consultations and are actively building up more resources to help the community. There are also plenty of social/volunteer organizations like SAMH, Silver Ribbon and CHAT, which you can tap on as well.
In-person therapy - Probably the most well-known form of treatment and the gold standard for talk therapy - nothing really replaces the level of engagement and real-time feedback that comes with face-to-face conversation. The only downside is cost - a standard 1 hour private therapy session can easily cost upwards of $200, and even within private practice, waiting times for a first session can be as long as 2 months. If you choose the subsidized public health route with a specialist referral, you should expect to wait at least twice as long. Furthermore, it's often difficult to find a therapist who's a good fit for you the first time around. The unfortunate reality is that in Singapore, the capacity for professional mental health treatment is vastly outnumbered by demand, which is a big part of why I'm writing this article in the first place.
Psychiatric medication - In most cases, therapy is often accompanied by a prescription of psychiatric medication. The story here is largely the same as above - private health consults are usually much faster but far more expensive, while public health options have much longer waiting periods. The actual medication might also be expensive depending on patents and how long the drug has been in circulation. There are some tips for getting cheaper medications - you could get prescriptions from pharmacies in Malaysia, for example, and there are a few older clinics that are more affordable in general.
Self-research and treatment of underlying conditions - It may well be the case (as it was for me) that your mental health problems are symptomatic of an untreated underlying health condition. Unfortunately, there isn't really a well-documented path to getting a clear diagnosis, or any comprehensive test suite that can rule out the most common causes, so my best advice to you is to take the time to do as much research as you can. I'm happy to offer some advice from my own journey - just send me an email at emmaneugene@gmail.com
Recommendations
In a nutshell, there are 3 main problems I see with the current system of mental health treatment in Singapore. The first and most obvious one is the stigma that still surrounds the topic. Secondly, the way that mental health is currently framed divorces it from environmental and social settings and puts the burden of recovery on the individual. Finally, the current treatment options available are often expensive and inaccessible, and public health authorities seem very reluctant to explore alternative treatments. I'll explain all of these points in further detail and make some personal recommendations for how I think things can be improved.
First, the attitude and prevalent stigma relating to mental health. Any discussion about psychological disorders like anxiety, depression, schizophrenia or BPD is still treated as taboo, and you'll almost never hear about it in public. I personally found that in many cases, I had to use softer language to describe the problems I was going through (feeling anxious, poor sleep, stuck in a rut, lacking motivation) - rather than pointing to any specific mental health disorder. Such discussion is even more censored within work and school contexts, for fear of judgment or future repercussions. We’re all actively contributing to an environment where only a handful of people are willing to take the first step to start a conversation. This isn't to say that I think everyone should be sharing their anxieties and negative thoughts in public. But I do think that it should be a normal and acceptable thing for anyone to speak about should they choose. Mental illness should not be treated any differently from physical illness. Everyone has their own inner demons, and the sooner we learn to accept them for what they are, the easier it is to carry the weight. Moving forward, I want to make an effort to involve myself further in the mental health scene and continue to contribute through writing and volunteering.
If there's one phrase that could convey my thoughts about how mental health should be regarded at a policy level, it would be that prevention is better than cure. There are many ongoing efforts aimed at bolstering the overall capacity for mental health treatment and care, but in my opinion, these interventions are too little too late. Instead, we should be looking at the broader social and cultural forces that make mental health issues more prevalent in the first place. If I'm being honest, the current narrative when it comes to dealing with mental health goes a little like: "Take some time off to sort out your own shit, and come back and join us when you're ready. We don’t really want to deal with your problems." - which really doesn't make any sense if the goal is to improve mental health outcomes on the whole. At best, all that these measures accomplish is maintaining a highly deficient status quo. I would like to see policies targeted at improving public health, enforcing better working conditions and rights for workers, and organizing activities that increase social engagement within local communities. Mental health treatment does not exist in a vacuum, and the sooner we realize this, the better.
My final recommendation would be to explore alternative avenues for the treatment of mental health conditions with other psychoactive compounds such as ketamine and psilocybin. I'll be the first to admit that I'm no expert on any of these agents, but there is a growing body of research that supports their use in treating chronic mental health conditions. At the moment, there are few if any affordable or accessible alternatives to antidepressants, whose mechanisms of action are not fully understood and often come with a host of side effects. I personally feel that this inertia is symptomatic of a restrictive and dogmatic culture which is failing to keep in touch with the present. If we’re really serious about mitigating mental health issues and giving ourselves the best chance of success, we should be giving individuals more options for treatment while also improving our understanding of mechanisms by which they operate.
Closing
I think I've basically unpacked everything I have to say on the topic of mental health at this point in time. At the end of the day, I truly believe that mental illness is not a curse but a compass - it's an opportunity for us to learn and course-correct not only as individuals but as entire communities and societies. We must face it earnestly for the lessons it can teach us on how to take better care of one another and live proper lives. For what it’s worth, I'm grateful for what I've been through, and I'm grateful to you, dear reader, for continuing to walk through each and every day with the people around you.
3 Questions for you
Are you lying to yourself, or actively avoiding the truth about something in your life? What are some steps you can take to face that?
When was the last time you expressed gratitude to a constant in your life?
When was the last time you made time for unadulterated play?
Catch you next time,
Emmanuel